Multiple Myeloma Cascade With Reflex to sIFE and sFLC

CPT: 84155; 84165
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Test Details

Test Includes

A Serum Protein Electrophoresis (SPEP) test is first run. If the SPEP is:1. Positive (ie, M-Protein present), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (eg, "IgG Kappa"). This finding will be reported and no further reflex testing will occur.2. Negative (ie, no M-Protein seen), a serum Free Light Chain (sFLC) test is automatically ordered and run (at additional charge). Then:• If the sFLC is Positive (ie, abnormal K/L ratio), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M- protein's heavy and light chain components (eg, "IgG Kappa"). This finding will be reported and no further reflex testing will occur.• If the sFLC is Negative (ie, no abnormal K/L ratio), no further reflex testing will occcur. A recommendation comment will be added to the report to "Consider ordering urine Immunofixation (uIFE) to rule out Amyloidosis (AL)."

Use

To maximize the clinical sensitivity of Serum Protein Electrophoresis (SPEP) when screening for plasma cell dyscrasias.

Methodology

SPEP: Protein electrophoresis on agarose media; IFE: Electrophoresis followed by immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains; Ig Quant: turbidimetric quantitation of IgG, IgA, and IgM; sFLC: immunologic quantitation

Additional Information

The analytical sensitivity of the commonly used serum tests for Multiple Myeloma (MM) screening is: SPEP < sIFE < sFLC with SPEP being the least sensitive and sFLC being the most sensitive detector of M-proteins.1

According to the International Myeloma Working Group (IMWG) guidelines, addition of sFLC and IFE to SPEP can prevent false negatives and increases the detection of multiple myeloma to >99%.2

Specimen Requirements

Specimen

Serum

Volume

5 mL

Minimum Volume

3 mL

Container

Red-top tube or gel-barrier tube

Storage Instructions

Refrigerate at 2°C to 8°C.

Stability Requirements

Temperature

Period

Room temperature

3 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Hemolysis; plasma instead of serum

Clinical Information

Footnotes

1. Katzmann, JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev. 2009 Aug;30(3):105-111.19841692
2. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009 Feb;23(2):215-224.19020545

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
123200 Multiple Myeloma Cascade 321489 Protein Electrophoresis,S N/A
123200 Multiple Myeloma Cascade 001073 Protein, Total, Serum g/dL 2885-2
123200 Multiple Myeloma Cascade 001488 Albumin g/dL 2862-1
123200 Multiple Myeloma Cascade 001489 Alpha-1-Globulin g/dL 2865-4
123200 Multiple Myeloma Cascade 001490 Alpha-2-Globulin g/dL 2868-8
123200 Multiple Myeloma Cascade 001491 Beta Globulin g/dL 2871-2
123200 Multiple Myeloma Cascade 001492 Gamma Globulin g/dL 2874-6
123200 Multiple Myeloma Cascade 001493 M-Spike g/dL 33358-3
123200 Multiple Myeloma Cascade 011052 Globulin, Total g/dL 10834-0
123200 Multiple Myeloma Cascade 011149 A/G Ratio 1759-0
123200 Multiple Myeloma Cascade 011150 Please note: N/A
123200 Multiple Myeloma Cascade 123201 Reflex Testing N/A
123200 Multiple Myeloma Cascade 123203 MM Cascade Reflex Storage N/A
123200 Multiple Myeloma Cascade 001498 PDF N/A
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001497 Immunofixation Reflex, Serum N/A
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001776 Immunoglobulin G, Qn, Serum mg/dL 2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001784 Immunoglobulin A, Qn, Serum mg/dL 2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001792 Immunoglobulin M, Qn, Serum mg/dL 2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 149519 Immunofixation Result, Serum 13169-8
Reflex 2 000000 149532 000000 13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121138 Free Kappa Lt Chains,S mg/L 36916-5
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121139 Free Lambda Lt Chains,S mg/L 33944-0
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001497 000000 N/A
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001776 000000 mg/dL 2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001784 000000 mg/dL 2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001792 000000 mg/dL 2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 149519 000000 13169-8 149532
Reflex 3 000000 149532 000000 13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001497 000000 N/A
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001776 000000 mg/dL 2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001784 000000 mg/dL 2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 001792 000000 mg/dL 2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 149519 000000 13169-8 149532
Reflex 3 000000 149532 000000 13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121140 Kappa/Lambda Ratio,S 48378-4
Reflex 2 000000 123303 000000 N/A

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